Question Title: ETS to cure Hyperhidrosis

Forum: Neurology Forum
Topic: Neurology - General

Posted by CCF NEURO MD on May 20, 1997 at 13:06:13:

In Reply to: Re: ETS to cure Hyperhidrosis posted by CCF NEURO MD on May 20, 1997 at 12:59:16:

: : I have Hyperhidrosis and have found that ETS would

: "cure" Hyperhidrosis. I put "cure" in quotations

: because there has not been any long term studies

: on the effectivenes of ETS. But short term seems

: promising.

: I am concerned about complications like Horner's

: syndrome and other neurological disorders and

: sensory deficits. I am having a hard time finding

: experienced surgeons in the United States to consult.

: Do you have any opinions or information on this procedure?

: Thank you for your time.

I am unable to comment on the accuracy of this reference. Here is the exert from the reference:

Overview

Sweating is a natural phaenomenon necessary for the regulation of an individual's

body-temperature. The secretion of sweat is mediated by a portion of our

vegetative nervous system (the Sympathetic Nervous System). In some people

(approximately 1% of the population), this system is working at a very high activity

level, far higher than needed to keep a constant temperature. This condition is

referred to as hyperhidrosis.

Classification and Causes

Causes

* primary = essential = idiopathic (unknown cause)

* secondary (known cause)

Locations

* palmar (hands)

* axillary (armpits)

* plantar (feet)

* facial (face)

* truncal (trunc)

* general

1. Hyperhidrosis as part of an underlying condition (secondary hyperhidrosis)

Some conditions can promote excessive sweating, as a rule involving the whole body:

* Hyperthyroidism or similar endocrine diseases

* Endocrine treatment for prostatic cancer or other types of malignant diseases

* Severe psychiatric disorders

* Obesity

* Menopause

2. Hyperhidrosis without known cause (=primary or essential hyperhidrosis)

This is a far more frequent condition than secondary hyperhidrosis and appears, generally,

localized in one or several locations of the body (most often hands, feet, armpits or a

combination of them). It usually starts during childhood or adolescence and persists all life.

Nervousness and anxiety can elicit or aggravate sweating, but psychological/psichiatric

disturbances are only rarely the cause of the disorder.

Manifestations of Primary Hyperhidrosis

Palmar Hyperhidrosis

Excessive sweating of the hands is, generally, by far the most distressing condition. The

hands are much more exposed in social and professional activities than any other part of

our body. Many individuals with this condition are limited in their choice of profession,

because unable to manipulate materials sensitive to humidity (paper etc) or reluctant to

shake hands; some patients arrive to the point to avoid social contact. The degree of

sweating varies and may range from moderate moisture to dripping. Most patients notice

that their hands not only feel moist, but also cold.

Axillary Hyperhidrosis

Also hyperhidrosis of the armpits can be embarrassing causing large wet marks and

sometimes a white halo of salt from sweating on the cloths.

Plantar Hyperhidrosis

Other locations

Less frequently, it is located only to the trunc and/or the thighs. Other patient are suffering

from copious sweating in the face.

* Many individuals suffer form a combination of the above cathegories.

* Sweating can appear suddenly or manifest itself more continuously.

* It can be elicited by high outside temperatures or emotional stress, or appears without any

obvious reason.

* Generally, it worsens during the warm season and gets better during winter.

Treatment

In secondary hyperhidrosis, the underlying condition should be treated first. Patints on hormonal

therapy for prostatic cancer (castration, LHRH-analoges) with disturbing sweat attacks can get

relief by the administration of antiestrogens (ciproterone acetate).

In patients with primary hyperhidrosis or for symptomatic treatment of heavy sweating in patients

with secondary hyperhidrosis, not treatable otherwise, the following methods have been adopted.

In psychiatric patients with hyperhidrosis, successful treatment this symptom often reduces the

tendency towards emotional distress.

Antiperspirants

Iontophoresis

Drugs

Psychotherapy

Surgery

Other treatment methods

ANTIPERSPIRANTS

Usually recommended as the first therapeutic measure. The most effective agent

appears to be alluminum chloride (20-25%) in 70-90% alcohol, applied in the

evening 2-3 times/week. Generally, this treatment is sufficient in cases with light to

moderate hyperhidrosis but has to repeated regularly.

IONTOPHORESIS

Can be tried if antiperspirants have not lead to the desired result. This method

consists in applying low intensity electric current (15-18 mA), supplied by a D/C

generator, to the palms and/or soles immersed in an electrolyte solution. The

procedure has to be repeated regularly, initially in 20' sessions several times/week,

gradually stretching out the interval between treatments to 1-2 weeks. The results

vary: many patients, suffering from light or moderate hyperhiderosis, are happy with

the method, some may consider it too time-consuming or inefficient, and

comparably expensive. It is difficult to apply in axillary, and impossible to use in

diffuse hyperhidrosis of the face or the trunc/thigh region.

Equipment, specifically designed for the treatment of hyperhidrosis at home or in the

physician's office, is commercially available from different suppliers.

DRUGS

There are no specific drugs available against profuse sweating. Psychotropic (mostly

sedative) and/or anticholinergic drugs are often tested but show usually too many

side-effects before any noticeable result can be achieved. Hence, they are, as a rule,

not recommended. In those few cases who suffer from profuse sweating on the

trunc (but not the extremities), a low dose of anticholinergic agent can slightly

alleviate the symptoms without rendering life unsupportable from side-effects (dry

mouth, accomodation difficulties of the eyes, etc), but a dosage necessary to

normalize the amount of sweating will rarely be tolerated.

PSYCHOTHERAPY

Very limited effect in the absolut majority of patients. Psychological problems are in

most cases a consequence of hyperhidrosis, not the cause. Hence, psychiatric or

psychopharmacologic therapy cannot cure this disorder, at most it may help the

patient to accept living with the problem.

SURGERY

Excision of the axillary sweat glands

Patients with axillary hyperhidrosis who are unresponsive to medical therapy

can be effectively treated by excision of the axillary sweat glands. If sweating

extends beyond the hairy portion of the axilla, several skin incisions may be

needed, sometimes resulting in formation of hypertrophic and/or constrictive

scars.

Sympathectomy

- The principle of sympathectomy is to interrupt the nerve tracks and nodes

(ganglia) which transmit the signals to the sweat glands. Basically, this can be

achieved for all locations in the body, but only the nerve nodes responsible

for the sweat glands of the palms, the armpits and the face are accessible

without the need for a major surgical procedure. Today, the treatment of

choice for moderate to severe palmar and facial hyperhidrosis (but also

axillary, especially if combined with palmar sweating), consists in a surgical

procedure known as Endoscopic Thoracic Sympathectomy. This

minimal-invasive endoscopic technique has been developed in recent years in

a few hospitals in Europe, superseeding Conventional Thoracic

Sympathectomy, a very traumatic procedure performed in the past. The

endoscopic technique is very safe, if performed by a surgeon experienced in

this type of procedure, and leads to definitive cure in nearly 100% of patients,

leaving only a minimal scar in the armpit.

- Individuals with combined hyperhidrosis of the palms and soles have a

good chance to improve teh sweating of their feet after an operation aiming to

suppress sweating of the hands. Isolated plantar hyperhidrosis can, however

only cured by Lumbar Sympathectomy, an open abdominal procedure.

- Diffuse hyperhidrosis of the trunc or general sweating of the whole body

cannot be treated by surgery.

OTHER TREATMENT METHODS

"Alternative Medicine"

In the experience of the author, many patients, disappointed by the treatment

offered by their doctors, have tried different methods of alternative therapy

including homoeopathy, massage, acupuncture and phytotherapeutic drugs, in

almost all cases without noticeable improvement.

"Lasertherapy"

Some desperate patients have undergone this kind of treatment, involving

direct irradiation of the palms and resulting in 3rd degree burn lesions with

heavy cicatrisation, without any effect regarding sweating. This technique is

absolutely contra-indicated.

Hypnosis

There are no systematic studies on this method. Few patiens have tried it,

reporting poor results on palmar hyperhidrosis.

Botulinus toxin

A family of toxins produced by a bacteria known as Clostridium botulinum.

This toxin is one of the most lethal poisons known, interfering with the effect

of the transmitter substance acethylcholine at the synapses (the contact point

of a nerve ending with another nerve cell or a muscle) and leading to

progressive paralysis of all muscles in the body, including the respiratory

muscles. In extremely low doses, botulinus toxin has been adopted in cases

with localized muscle hyperactivity (lid spasms, torticollis, etc), resulting in a

reduction in transmitting impulses to the muscle. No official reports are so far

available regarding this treatment in hyperhidrosis. Reduction in activity of the

autonomous system (dry mouth, bladder paralysis, bowel inactivity) is a

known phaenomenon in severe botulism (botulinus poisoning), but will hardly

be achieved without detrimental side-effects on the muscle activity.

Here is a reference for the surgical treatment. Again, I have no experience with this group, so this is in no way a recommendation. However, it may be a useful tool to finding you appropriate therapy. If you undergo a treatment of any sorts, I would recommend a academic institution. Their treatments are usually the most advanced.

US-Coordinator: Ruth Matti

SURGICAL TEAM ADVISERS, INC.

5445 Collins Avenue, Suite CU-8-A

Miami Beach, FL 33140

Phone: (305) 868-8181, (800) 548-0395

Fax: (305) 868-8188

E-mail: SwedenUSA@msn.com

Horner's syndrome is characterized by ptosis (drooping of the eyelid), miosis (constriction of the pupil), ipsilateral facial anhidrosis (lack of sweating). There is no other associated symptoms that should be associated with this. The ill effects are mainly cosmetic. If you go through with any procedure make sure you discuss the side effects of the treatment and the physicians success rate as well as complication rate. They will be able to give you better percentages for complications.

[Neurology Forum]      [Neurology Forum Archives]